Dr. Paul Farmer tells Yale audience: Good health care starts in the community

Dr Paul Farmer, Harvard medical school prof. and founding director of Partners in Health, starting his lecture "The Corporal works of mercy and the 21st century struggle against poverty" Thursday evening April 26, 2012 at the Yale Divinity School's Marquand Chapel. vm Williams 04.26.2012

NEW HAVEN -- Health care activist Dr. Paul Farmer has just one problem with people who make health care determinations based on cost effectiveness. They usually have no real knowledge about cost or effectiveness.

Farmer's approach to treating the world's neediest patients is much more direct: Give poor people medicine. Find out what's making them sick. Fix those things too, with as many community-based partners as you can get.

That's how he and his colleagues at Partners In Health have helped thousands of impoverished patients in Haiti, Rwanda, Russia, Peru and other places around the world.

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"I believe these lessons are applicable in the United States, where we're involved with patients who have fallen through the cracks," said Farmer, in a standing-room-only lecture at Yale Divinity School that filled Marquand Chapel and two overflow rooms where the speech was broadcast.

"The best place you can ever start to work in public health is in a squatters' settlement," Farmer said. "You learn to be very critical of claims of causality."

Farmer, an anthropologist as well as a physician, is chairman of the Department of Global Health and Social Medicine at Harvard Medical School. He worked for a decade as medical director of a charity hospital in Haiti, and he's currently the U.N. deputy special envoy for Haiti.

His books include "Infections and Inequalities," "AIDS and Accusations" and "Partner to the Poor: A Paul Farmer Reader." He's also a former recipient of a MacArthur Foundation "genius" grant.

"He's dedicated his life to helping the poorest of us," said Diana Swancutt, an associate professor at Yale Divinity School.

Farmer said much of what he came to learn about poverty and health care happened through necessity and chance. He'd gone to Haiti in the early 1980s to work at a clinic.

"It was a nightmare," he recalled. "I didn't even know who to talk to about it."

He saw poor people paying for irrelevant care that didn't make them better. He saw people lining up at the local pharmacy for "whatever syrup of the day was being offered."

The experience led him to leave that clinic and help start a new one from scratch. "It is a place that has been built room by room, and not with a master plan," he said.

Farmer's work would take him around the world. Among other things, he's treated tuberculosis patients at a Russian prison and helped open a public hospital in Rwanda.

Community-based health care, Farmer said, is the best way to establish a high standard of care. "I don't know how to do this without community health workers," he explained.

Also, he noted, health care must be viewed in the wider context of employment opportunities, access to credit and education. Only by understanding a community can health care practitioners be successful in making people better.